Treatment options
Many treatments are available - including dissolving the stones, shattering the stones, removing just the stones or removing the whole gallbladder. The only treatment in common use is removal of the gallbladder. The other treatments are not universally applicable, may not be as safe and risk a high recurrence of gallstones. I will, therefore, concentrate only on removal of the gallbladder (cholecystectomy).
These days most surgeons perform laparoscopic cholecystectomy ('keyhole' surgery). In order to do this the operating instruments have to be introduced into the abdomen ('tummy') and space created inside the abdomen to allow the operation to be carried out. Metal or plastic tubes (ports - usually 4 are used) that have valves in them to stop the leakage of gas are inserted through the abdominal wall. The abdomen can then be distended with carbon dioxide gas to create the space needed. The pictures below show the ports in place (the abdomen has been distended with gas) and the scars that are left at the end of the operation.
In order to see inside the abdomen a special camera and light system are used. The operation then involves the identification of the cystic duct and the cystic artery. These are clipped and divided. The gallbladder is then separated from the liver using diathermy. To give a clear view the operation site can be 'washed' with sterile salt solution. Once the gallbladder is separated from the liver it can be removed from the abdomen through one of the port sites (occasionally a specially designed bag is used for this purpose). The following video clip shows the highlights of the operation - to start the clip move your mouse over it.
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In the majority of cases the gallbladder can be removed laparoscopically. In 5-10% of cases, however, it cannot be done this way - this may be for technical reasons (poor view, light source not working, gas escapes so that abdominal distension cannot be maintained) or for clinical reasons (there is extensive scarring around the gallbladder, the anatomy is not clear or cannot be seen properly because of bleeding). If this happens, the operation will be converted to the 'open' technique. This involves a 6-8 inch incision under the ribs on the right. This technique is more painful and recovery at home is much longer (4-6 weeks compared to 1-2 weeks for laparoscopic surgery).